| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
38,042 |
37,481 |
$2.05M |
| D1110 |
Prophylaxis - adult |
15,822 |
15,482 |
$1.01M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,665 |
11,512 |
$737K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
11,146 |
4,264 |
$644K |
| D9420 |
|
723 |
701 |
$628K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,193 |
5,133 |
$560K |
| D7140 |
Extraction, erupted tooth or exposed root |
13,022 |
6,682 |
$472K |
| D0330 |
Panoramic radiographic image |
3,795 |
3,709 |
$427K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,595 |
4,834 |
$337K |
| D0210 |
Intraoral - complete series of radiographic images |
1,200 |
1,198 |
$201K |
| D1120 |
Prophylaxis - child |
30,580 |
30,207 |
$151K |
| D1206 |
Topical application of fluoride varnish |
18,531 |
18,320 |
$140K |
| D1351 |
Sealant - per tooth |
39,317 |
10,425 |
$136K |
| D0272 |
Bitewings - two radiographic images |
27,915 |
27,575 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,411 |
10,190 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
27,646 |
27,201 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,885 |
16,661 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
3,744 |
3,688 |
$55K |
| D1330 |
|
45,352 |
44,682 |
$44K |
| D0274 |
Bitewings - four radiographic images |
13,105 |
12,799 |
$32K |
| D2390 |
|
381 |
157 |
$23K |
| D9920 |
|
758 |
736 |
$19K |
| D9248 |
|
43 |
43 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
83 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
135 |
135 |
$8K |
| D2330 |
|
282 |
196 |
$8K |
| D1354 |
|
1,907 |
722 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
27,567 |
27,083 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
236 |
236 |
$6K |
| D1510 |
|
48 |
37 |
$5K |
| D0603 |
|
4,416 |
4,361 |
$5K |
| D3120 |
|
378 |
286 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
86 |
86 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
519 |
369 |
$1K |
| D0601 |
|
169 |
167 |
$523.00 |
| D1999 |
|
12 |
12 |
$480.00 |
| D0602 |
|
219 |
216 |
$378.00 |